CSF Flow Study part 1

We spent President's Day getting our CSF Flow studies done at Dallas Children's Hospital.  The flow studies are actually "videos" and so I can only post pics of them.

Olivia's Brain report:

FINDINGS: (for the Brain)

The sagittal images shows the corpus callosum is normally formed.

The cerebellar tonsils extend 5 mm below the level of the foramen magnum. The CSF flow images show paucity of CSF flow along the dorsal aspect of the foramen magnum along with abnormal neural movement in 4 out of 30 phases of the cardiac cycle. The
dynamic images show downward and anterior movement of the cerebellar tonsils and brainstem. The ventral aspect of the brainstem abuts the dorsal aspect of the dens on the dynamic images.

The optic chiasm, optic tracts, and optic nerves are normal. There is a normal hyperintense neurohypophysis within the sella turcica.

Axial images show normal ventricular size and configuration. There are no pathologic extracerebral fluid collections. There is normal signal intensity in cerebrum, basal ganglia, thalamus, brain stem and cerebellum. There is no restricted diffusion.
There is age-appropriate myelination pattern. There is no cortical dysplasia.

Normal signal voids are seen within the intracranial vascular structures. The paranasal sinuses are clear. The mastoid air cells are clear. The orbital contents are normal.   

IMPRESSION:

Chiari I malformation with abnormal CSF flow dynamics.
Please refer to separate dictated report for details of the syrinx in the upper cervical spine.


Olivia's Spine Report:

FINDINGS: (spine)

Alignment: There is normal alignment of the spine. The vertebral body heights and intervertebral disc spaces are normal.

Marrow: Marrow signal is normal.

Cord: The conus terminates at L1 vertebral body level. There is normal appearance of the filum terminale. There is an expansile multiloculated syrinx within the cervicothoracic region extending from C4-C5 intervertebral disc space level inferiorly to
T2-T3 intervertebral disc space level. This measures 8mm in its maximum diameter. There is an expansile syrinx at T7 level as well as within the conus. There is also a filar cyst, just inferior to the conus.

The cerebellar tonsils are low lying. There is normal signal in the spinal cord.
Soft tissues: The prevertebral and paraspinous soft tissues are normal. The vertebral artery flow voids are patent. There is no hydronephrosis. 

IMPRESSION:
Multilevel expansile syrinx within the spinal cord. This appears stable, in comparison to outside MRI dated 9/13/2013.

So, basically, Olivia's CSF doesn't appear to being flowing right and her ondontoid is touching part of the brainstem.  A friend had me start studying "Deformative Stress".  It appears to be related to EDS somehow.  The other thing is that it appears the syrinx's in Olivia's spinal cord are "stable".  I would have preferred them to say "resolving".  Here is where I take a huge SIGH.

Here are some pics of Olivia's newest MRI.  The first picture shows how the ondontoid appears to be pushing in on the brainstem.  The second pic shows the area of concern circled in purple.

 

 

                                               This picture shows the "Filar Cyst"

                                                   This picture shows the syrinx in the thoracic area that is large (black spot in the lower part of the picture)

                                          This picture shows the other syrinxs that don't look any different. The Chiari is also very apparent. 

 

Now here is the report for Abrianna's Flow study:

 

FINDINGS:

The sagittal images shows the corpus callosum is normally formed.

The cerebellar tonsils extend 5 mm below the level of the foramen magnum. There is paucity of CSF flow along the dorsal aspect of the foramen magnum along with abnormal neural movement in 5 out of the 30 phases of the cardiac cycle. The dynamic images
show downward and anterior movement of the cerebellar tonsils along with minimal movement of the brainstem and no impingement on the subarachnoid spaces by the neural tissue is.

The optic chiasm, optic tracts, and optic nerves are normal. There is a normal hyperintense neurohypophysis within the sella turcica.

Axial images show normal ventricular size and configuration. There are no pathologic extracerebral fluid collections. There is normal signal intensity in cerebrum, basal ganglia, thalamus, brain stem and cerebellum. There is no restricted diffusion.
There is no cortical dysplasia. There is age-appropriate migration pattern.

Normal signal voids are seen within the intracranial vascular structures. The paranasal sinuses are clear. The mastoid air cells are clear. The orbital contents are normal.  

 

IMPRESSION:

Low lying cerebellar tonsils with normal CSF flow dynamics.

 

 

So, reading this report she has "abnormal" flow in at least 5 out of the 30 cycles, but they said she had normal flow.  They also diagnosed this as "low lying cerebellar tonsils" WITH "normal CSF flow dynamics."  So, I called the neurosurgeon's office and spoke with his assistant.  I advised that I do not know how you can have abnormal flow and tonsils beyond the measurement for chiari 1 and be "normal".  I sure hope she is, however, I don't know how Olivia's report gives her the same measurements, 1 less abnormal flow and gets her the Chiari diagnosis with abnormal flow.

 

I just simply feel that it is ridiculous that we pay for an MRI and can't even get a correct report.  So far with MRI's I have learned three things:

 

1.  CLEARLY understand how the anastesiologist will be knocking out your child and discuss prior successful anesthetic events.  For instance, in Oklahoma City and Dallas they use gas to start sedation so they can insert the child's IV without it being so tramatic. 

 

2.  Make sure they put your kid in STRAIGHT in the MRI so that you don't end up with a crazy rabbit trail worried that your child has scoliosis on top of your other worries.

 

3.  Ensure that you get your MRI disks IMMEDIATELY and take your laptop to ensure the images are readable right then and ask for at least 2 copies of the disks.  Also, call and get a copy of your MRI report a few days after your test.   More than likely, you will get the report LONG before your ordering doctor will realize they have one to read.

 

I'll repost a follow-up when we learn if Abri's report will be re-done.